Home blood-glucose measurements without reflectance meter

Home blood glucose monitoring--the key to good control

Home blood glucose monitoring is one of the corner-stones in the management of type I diabetes. This paper summarizes the aims and effects of this method and will discuss the pros and cons with simple patient-adapted meters and visual judgement of the blood glucose strip. It is underlined that a thorough handling of the strip is essential for the result whatever method used. The problem solving capacity of home blood glucose monitoring in unstable diabetes is illustrated.

Home monitoring of blood glucose and insulin therapy without a photometer

The BM-Test-Glycemie 1-44 test strip facilitates self-monitoring without the use of a photometer. In a population of 33 diabetic patients (age 24.8 +/- 2.9 years) 94% took part in home monitoring for 6-10 months. Of 29 who answered a questionnaire 25 preferred blood glucose testing to urine testing. In a "beta-cell school" it was taught that it is rational if home monitoring of blood glucose is combined with a tailored insulin treatment consisting of long-acting insulin (Ultralente) as a basal insulin and regular insulin (Actrapid) as a meal insulin. In a group of 24 labile diabetic patients 17 preferred this regime compared to earlier use of intermediate acting insulin and regular insulin. Six of these preferred the regular insulin to be taken in three doses. Hypoglycemia, when it occurred, was less distressing in symptoms than previously. Among patients with recent onset of diabetes active participation with dose reduction was seen during the honey-moon stage. The regime is logical and generative, offers a basis for an individualized therapy and a high remission frequency may be expected.

Empowerment of diabetics: a challenge for community nursing

Empowerment of diabetic patients can be promoted by the use of blood glucose self-monitoring. Community nurses play an important role in teaching effective and accurate techniques.

Capillary blood glucose monitoring

The complications associated with inaccurate capillary blood glucose monitoring and poor control of diabetes are well known. This article explores the research identifying potential causes of inaccurate testing, examines ways of minimizing error and investigates quality control issues.

Comparison of ease of learning of four glucose meters

This study examined the ease with which subjects were able to learn to use four blood glucose meters: Glucoscan 3000, Glucometer II, Accu-Chek II, and Diascan. Diabetes educators taught use of meters to 42 subjects in groups of three or four over two hours. Order of presentation was controlled by repeated measures Latin Square design. Twenty-five minutes were allowed for instruction and return demon stration of each meter. Subjects performed tests until three consec utive tests fell within the expected range or the allotted time was completed. Visual analog scales (eg, ease of learning, calibration, starting, testing, reading, and lack of confusion) were completed by subjects immediately following use of each meter. Statistically significant differences were found between meters. Overall ranking (easiest to hardest) was Glucoscan 3000 > Diascan > Glucometer II > Accu-Chek II. In addition to consideration of these results, educators still need to consider the individual in selecting the appropriate meter.

Blood glucose monitoring by children at home: a comparison of methods

The accuracy of measurements of blood glucose performed at home by the index children and/or parents was compared using the Boehringer Mannheim reagent strips, Ames Visidex-2 strips, an Ames Glucometer and a Boehringer Mannheim Reflolux reflectance meter. Capillary plasma samples, collected simultaneously, were later analysed by a Beckman glucose oxidase analyser. The coefficient of correlation between the self-monitored results (SMR) and the laboratory-analysed results (LAR) ranged from 0.59 to 0.92, the composite being 0.74. The mean difference between the SMR and the LAR was 1.0 mmol/l. The occurrence of potential errors of management due to incorrect SMR results was determined. On four occasions, the SMR was greater than 6 mmol/l when the LAR was less than 3 mmol/l, and on 36 occasions a discrepancy greater than 50% occurred between the two values, without resulting hypoglycaemia.

The stability of Chemstrip bG used in conjunction with AccuChek bG

Reacted Chemstrip bGs were 1) stored in the original desiccated vial, 2) covered with white paper, or 3) left exposed on a counter, and were read at intervals of 10 hours, 1 day, 2, 3, 5, 7, 10, 14, and 21 days with AccuChek bG. Blank strips stored under the same conditions were used to calibrate the AccuChek bG. Blood glucose samples ranged from 60 to 400 mg/dl and read within 10 % of the original glucose con centration after 5 days. The strips remained within 79-100% of the initial value for 3 weeks, depending upon the blood glucose range. The find ings of this study are consistent with the manufacturer's claim that developed strips are stable for 7 days up to 320 mg/dl and for 4 days above 320 mg/dl when stored as recommended.

Increasing the Accuracy of Blood Glucose Values Using Visually-read Chemstrips

Four insulin-dependent diabetic adults were exposed to a feedback program designed to improve accu racy of blood glucose values obtained by patients using visually interpreted Chemstrips. Three of the four subjects demonstrated a dramatic increase in agreement between visually deter mined and reflectance photometer de termined blood glucose values follow ing exposure to the feedback treat ment. The implications of these find ings are discussed.

Evaluation of Visidex II--a new strip for blood glucose measurement

We have evaluated a new blood glucose test-strip (Visidex II, Ames), which does not require washing with water after contact with blood. Visidex II showed a significant negative bias when compared with a similar diagnostic strip (BM 20-800, Boehringer) and with the Beckman II glucose analyser (p less than 0.001 in both cases), and a poorer correlation with either method than BM strips with the Beckman II. A significant number (6.3%) of Visidex strips in this study were unreadable due to removal of the colour pads on blotting, and some difficulty was reported by patients in reading values around 6-8 mmol/l. Visidex II can safely be stored in the refrigerator and developed strips may be stable longer than BM strips. A significant error in reading was noted if the incubation time was varied by +/- 5 seconds. Further experience and perhaps some modifications may be necessary before Visidex II can be recommended for widespread use.

Reagent strip performance as evaluated by a meter

The stability of 98 Chemstrip bG (CS) was assessed with a specially de signed meter (Accu-Chek) to deter mine the length of time patient-read CS can be saved in order to evaluate the accuracy of self-monitoring. Visual readings of 70 CS from 21 patients were compared with meter readings immediately after capillary blood glu cose (CBG) determination to assess patient accuracy.

The rate with which meter-read CS changed was significant by three days (p<0.001). To determine the clinical significance of this change, the abso lute values of initial meter readings were compared to subsequent meter readings for 14 days. Significant changes in CBG values occurred after 5-10 days dependent upon the initial CBG value. If the initial CBG value was less than or equal to 180 mg/dl, CS deteriorated significantly after ten days. When the initial CBG value was greater than 180 mgldl, significant deterioration occurred after five days. Patient accuracy was found to be 97% ± 15.

In conclusion, (1) when properly stored, CS can be saved for up to ten days in order to assess individual pa tient accuracy in performing self-moni toring, and (2) despite considerable variability, patient interpretation of CS is accurate.

BM strips: how accurate are they in general wards?

In order to test the accuracy of BM Test Glycemie 20-800 strips when used in general wards, simultaneous BM strip results were obtained for 183 emergency out-of-hours plasma glucose requests. The results were considered accurate if the value obtained by the Emergency Biochemistry Laboratory (using a Beckman II glucose analyser) was within one strip-range on either side of the stated BM strip value. Fifty-nine (32.2%) of the BM strip results were considered inaccurate by this definition, and in 22 of these inaccurate results the differences were large enough to have led to inappropriate management if this was based on the BM strip result alone. The reasons for these inaccuracies are not clear, but it is suggested that improved training of ward staff and formal quality control schemes may help to improve results.

Nurses' performance and interpretation of urine testing and capillary blood glucose monitoring measures

This descriptive study attempts to identify the ways Registered Nurses (RNs) perform and interpret diabetic urine testing and capillary blood glucose monitoring measures. Seventy per cent of the RNs from one acute care hospital participated in the study. Seventy-six nurses participated; five of these comprising the pilot study. It was concluded that RNs did not perform these tests accurately according to standards. Knowledge of specimen collection procedures and drugs which affect urine testing results was not consistently high. RNs perceived the definitions of hypoglycaemia, normoglycaemia and hyperglycaemia more widely than standard ranges thus having major implications for patient care. RNs' experience with tests is not necessarily related to the accurate completion of the tests. Implications, limitations and idiosyncrasies of each test should be taught in addition to procedural specifics so that nurses can make sound judgements for patient care.

Audit in a Diabetic Clinic

Diabetic control was assessed in 82 established insulin-dependent diabetics using a microcapillary system for home preprandial blood glucose sampling. At initial assessment control in the majority (62%) was found to be unsatisfactory (at least 1 preprandial blood glucose greater than 13.0 mmol/l or frequent and severe hypoglycaemia). Sixty-three of these patients were assessed on more than one occasion. Only 24% were satisfactorily controlled at their first assessment, but this proportion had risen to 60% after 12 months. The ability of patients to perform unsupervised blood glucose levels using Ames Glucometers or BM-Glycemie 20–800 test strips was also assessed: 86% of the meter results were within one-third of the laboratory-based results, but there was evidence of bias towards the under-reading of higher glucose values using BM-Glycemie 20–800 test strips. Random blood glucose estimations performed in the diabetic clinic were of little value.

Impact of home blood glucose monitoring on childhood diabetes

Ninety diabetic children each provided at least one 24-hour blood glucose profile at home using an impregnated filter paper strip. The mean 24-hour blood glucose level correlated significantly with urine control, height velocity, and Hb A1. The correlation coefficient for individual blood glucose values (r = 0.61) and for mean 24-hour blood glucose values (r = 0.73) repeated within 14 days showed an acceptable degree of reproducibility for the blood glucose profiles. Mean 24-hour blood glucose values fell significantly overall (11.4 to 9.8 mmol/l; 205 to 176 mg/100 ml) in 47 children who had repeated profiles more than 2 weeks apart. Unrecognised nocturnal hypoglycaemia (less than 3.0 mmol/l; 54 mg/100 ml) was found in 19% of children on twice-daily Semitard insulin. The study shows that children over age 7 years manage home blood glucose monitoring without difficulty. It shows that the results are reproducible and correlate with other indices of control, and that it provides a practical basis for the improvement of diabetic control.

A novel five-microlitre capillary system for home glucose monitoring

Improvement in the control of diabetic patients is aided by a knowledge of blood glucose levels during a 'normal' (non-hospitalised) day. We have devised a 5 microliter capillary tube collection system as a 'kit' for home use by diabetics. Blood collected into 5 microliter capillary tubes is washed into a protein precipitant by the patient. The completed kit is posted to the laboratory for analysis. The technique has achieved a high degree of patient acceptability. Subsequent analysis involves the addition of a single reagent. Reagents, patient samples, and standards are stable, and the precision of the technique compares favourably with our routine glucose procedure.